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“NEW KIDNEY, NEW LIFE” – Doctor-Patient Trust Brings Joy to Many

By Bryan Adrian for Georgia Today


photo above of Dr. Irma Tchokhonelidze with legendary transplant surgeon, Dr. Jan Schmidt of Germany/Switzerland, and blind female kidney recipient


Bryan Adrian for GEORGIA TODAY

The current President of Georgia, Michael Saakashvili started the Rose Revolution in late 2003, and since 2011 on the 8th floor of Tbilisi’s new High Technology Medical Center University Clinic, in the Department of Renal Replacement Therapy and Nephrology, under the guidance of Dr. Irma Tchokhonelidze, a new revolution in medical practices in kidney healthcare, dialysis, and kidney transplantation, has gone into full swing in the struggling Republic of Georgia.

Dr. Tchokhonelidze’s philosophy leans heavily towards the doctor-patient trust relationship and she relies on her hand picked staff to carry out her vision.

Just two weeks ago, on Dr. Tchokhonelidze’s 8th floor in the High Technology Medical Center next door to the old “Aramiantsi clinic”, ten patients were being prepped for their transplant operations, each of them expectant of their “new kidney, new life,” thanks to the generous and precise master surgery of visiting Dr. Jan Schmidt, who flew in from Switzerland on the invitation of his professional colleague here in Tbilisi, Dr. Irma Tchokhonelidze. She had invited him for the third time in two years to come to Georgia and decrease the numbers of her patients with chronic kidney disease, those patients who otherwise would have to be attached for the remainder of their lives to a dialysis machine, all 50 of them running day and night in three shifts in her large nephrology clinic. How can this national Georgian dialysis patient-load be decreased, she asked herself? The magic and beauty of a kidney transplant is that with just one kidney transplanted into a diseased patient, it can free that patient forever from the grip of a hemodialysis machine. After a transplant, a patient needs only to take immuno-suppression pills for the rest of their years, effectively living a normal life, like everyday people with healthy kidneys. This is a very huge reward for the patient, who suddenly has no more need for dialysis whatsoever.

A transplant requires a lot of “patient-trust” in the doctor, a confidence known worldwide as a positive “doctor-patient trust relationship”. A transplant needs a lot of trust not only within the patient towards their transplant surgeon, but also lots of patient trust invested in the entire renal replacement nephrology department. Successful transplants incorporate many variables, such as sterilized hemodialysis machines, free of AIDS and hepatitis B and C, and spotlessly clean surgical tools and equipment. All this must be combined with an almost religious faith and trust in the expertise and experience of the surgeon. It is a team effort in which everyone plays an important part, both large and small.

Dr. Jan Schmidt has already performed over 12,000 operations in his long career, 900 of them transplants of different organs. His career stretches from Heidelberg Germany to Harvard USA, Sweden to Africa, the Middle East and Israel, and in 2005 Dr. Jan’s varied travel trajectory became connected for the first time to a Georgian patient. Dr. Schmidt performed his first transplant on a Georgian in 2005 in Heidelberg on a young Georgian boy, who has since been enjoying his new normal life in Georgia. The following year, in 2006, Dr. Schmidt was invited to come and address the students at Tbilisi State Medical University, where he met his colleague and future Georgian associate, Dr. Tchokhonelidze, whose skills in the German language and her knowledge of German developments in the field of nephrology, made him feel much more at home here in Georgia. By June 2011, Dr. Tchokhonelidze had become director of the department of nephrology in the new High Technology Medical Center University Clinic of Tbilisi, and the kidney transplantation program under her baton intensified nearly overnight.

Dr. Schmidt often does three transplants per day when in Tbilisi, which actually means six daily operations in all, due to Georgian restrictions on transplants being only from living and not cadaver donors. The living kidney donor is always a close family relative, by law in Georgia. In 2011 Dr. Schmidt completed three successful kidney transplants in Tbilisi, and during his 2012 visit he completed yet another seven transplants, and in 2013 still another 10 transplants, in addition to some very skillful abdominal cancer operations using a surgical virtuosity seen for the first time in the whole country of Georgia. When asked what is his special secret for having the stamina to conduct three transplants from living donor to recipient per day, for four or five days in a row, and sometimes a few non-transplant operations afterwards in the same day, he responded with a thoughtful yet faintly tired smile, “Go to bed at a decent time, and don’t drink or smoke,” the night before such strenuous procedures.

The ever modest Dr. Schmidt, despite his status and recognition as one of the leading transplant and abdominal surgeons in the world, told Georgia Today newspaper, “My philosophy is, always learn to do one thing well in your life, and for me, that one thing is surgery. I don’t do many other things so well …. I want to add, that surgery is what I most absolutely like to do in life.” He credited Dr. Tchokhonelidze in his next breath, “Please promote Dr. Irma, not me, she is the mastermind of this transplant arrangement and I am just her servant.” Dr. Jan concentrates on teaching his special medical skills, nearly as much as performing his successful surgical operations. His surgery and procedures are open to Georgian surgeons for observation while he is in Tbilisi. Each operation is video taped, also, for the future training of medical students and for already practicing surgeons within Georgia.

Georgia does not have yet its own greatly experienced solid organ transplant surgeons in its medical institutions at this time. The nation has only recently begun to enter such a learning curve among its professionals. There has never yet been a liver transplant performed anywhere in Georgia, and Dr. Jan Schmidt says he will make this a top objective the next time he arrives in Georgia, which is scheduled to be in early 2014.

Dr. Tchokhonelidze has an efficient staff of 6 female nephrologist physicians, all near the age of 30, and one male nephrologist, who is a contemporary of Dr. Tchokhonelidze. They all focus on the flawless administration of immuno-suppressant therapy during both pre-op and post-op transplant operations. Dr. Irma trained most of them in the newest methods and techniques gleaned from European and American and world nephrology medical journals, and from many internal medicine and nephrology lectures presented at several global congresses. Her whole team’s aim is to advance their clinic to the levels of European standards, as quickly as possible, albeit not too hastily either.

The owner and director of this entire HTMC hospital complex, Dr. George Ingorokva, since first opening the doors of his new hospital clinic facilities in 2009, has done an impressive job of providing the newest and best medical equipment possible, in a former CIS nation. This modern-equipped full medical facility is among the finest hospital complexes in the country of Georgia.

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Dr. Irma is hoping that the number of kidney transplants increases over the coming years, so as to free up the dialysis machines for more new and needy dialysis patients. She says, “Since 1997 the Government of Georgia has paid for kidney transplants from living donors who are related to the recipients. Before 2011, treatment of renal failure by dialysis was free for only a limited number, those lucky ones who fit into the restrictions of the federal budget, so some diseased patients who had to pay out-of-pocket, were left to die prematurely. Thank god, the government decreed in May 2011, just one month before I opened this new dialysis clinic, that all patients with chronic renal failure would receive free dialysis treatment. We no longer had to deny treatment for non-payment. It had been a torture during our long earlier era of dialysis, to abandon those without sufficient money and who the budget ignored.”

Dr. Irma says that she is very grateful that Dr. Jan has come as often as he has to Georgia to perform his magic surgery for very low payment, sometimes for free, and that she hopes he continues to come to Tbilisi for many more years. She says his fingers are so agile, focused, and extraordinarily skillful, she can only imagine that his surgical performances are equal to Mozart’s or Chopin’s fingers while they played the piano in their lifetimes.

“We need to expose our physicians to Western European and American methods and techniques and standards, as quickly as possible,” she insists. “Dr. Jan will train one of our surgeons in his techniques the next time he visits Tbilisi to perform more transplants.”

Meanwhile, the young female doctors on Dr. Irma’s staff are radiant with hope for the future of medicine in Georgia. One of them, Dr. Nino Maglakelidze, just recently completed a three month observation fellowship in the Belgian medical system. She says that she wants to implement what she saw and learned in Ghent, as expeditiously as possible here in Tbilisi. Another nephrologist on Dr. Irma’s team, Dr. Tamuna Kasradze, told Georgia Today that “from what my own eyes have seen, there is an enormous difference between Georgian surgeons and Dr. Jan Schmidt. He has much more experience.”

Dr. Nora Sarishvili on Dr. Irma’s team said “Dr. Jan is very glamorous in his surgical technique. I want to go abroad to Europe soon to advance my training, but I don’t yet have the funding!” She added that Dr. Irma inspired her to practice nephrology while she was studying under her in medical school. Dr. Nora’s mother is a pediatrician and her family had always assumed she would also practice medicine as a pediatrician. Her exposure to Dr. Irma changed all that.

At a dinner party in honor of Dr. Jan, thrown by ten elated former recipients of kidneys here in Tbilisi, transplanted under the scalpel of Dr. Jan’s earlier surgical visits, along with these ten grateful recipients were many of the donors of those same kidneys. Enjoying his dinner with them all was a very thankful young man named Tsotne, 22 years old, who earned his masters degree in England, who said:

“I went to England to earn my masters degree when I was 20 years old, and suddenly while there I was afflicted by debilitating chronic kidney failure, caused by Alport’s Disease, which had contributed to my grandfather’s death. It is a rare genetic disease. The UK insurance saved my life, they gave me an $18,000 peritoneal dialysis machine to use at home each night, a ten hour process while you are sleeping. I am so happy it saved my life, but it does dampen a young man’s activities socially, you can’t go out at night and you don’t meet girls that way. After one year and four months with my life dependent daily on a machine, I sometimes felt depressed. Then I heard about a famous German surgeon who was coming to Tbilisi to make kidney transplants. My family and me leaped at the opportunity! We don’t have surgeons like Dr. Jan Schmidt here in Georgia yet. I am so grateful to him. I live a normal life now, and I wish the same for many other dialysis patients.”

Among the appreciative kidney recipients at the 2013 farewell party for Dr. Jan, were an attractive blind girl in her 20s, with her mother. In addition, there was a young 15 year old boy with his father, who had donated his kidney a year ago to his son, and a sister who had donated a kidney to her brother. All were with irrepressible smiles on their faces, and they could not slow down their enthusiastic praises for Dr. Jan’s skillful talents.

Dr. Irma is hoping this cross-cultural program continues into the near and distant future, and that transplantation receives more funding from the Georgian government, and with more luck, from concerned investors also.

NON FICTION by Bryan Adrian 

FICTION by Bryan Adrian